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Cover Photo: A child being provided polio vaccine.

Source:

http://kathmandupost.ekantipur.com/news/2017-03-

06/18-officials-booked-for-disrupting-polio-drive.html Study Team Dr Sushil Baral Rajesh Ghimire Sudeep Uprety Kritagya Regmi Bipul Lamichhane

This report is produced by Health Research and Social Development Forum (HERD) as part of monthly media monitoring study conducted by Research Uptake and Communications Unit at HERD. The media monitoring exercise will be conducted for a year from Mangshir 2073 BS to Kartik 2074 BS.

http://kathmandupost.ekantipur.com/news/2017-03-06/18-officials-booked-for-disrupting-polio-drive.htmlhttp://kathmandupost.ekantipur.com/news/2017-03-06/18-officials-booked-for-disrupting-polio-drive.html

EXECUTIVE SUMMARY

Malnutrition is a serious health problem in

Nepal. According to Nepal

Demographic and Health Survey 2011,

41% of Nepali children are suffering from

chronic malnutrition. As a result, there is

high prevalence of death of children

due to malnutrition especially in remote

areas of Nepal.

Nutritious diet is vital for development of

children and can help to prevent many

diseases in the long run. Meanwhile, the

impact of malnutrition is as such that it

reduces immunity and impairs their

mental and physical development.

Consumption of poor nutritional diets has

affected proper growth and

development of children, caused many

related illness and has resulted in many

casualties among children particularly in

rural areas of Nepal. In a macro

perspective, malnutrition has affected

the national economic growth in Nepal

due to loss of productive labour resulting

in lower GDP.

Both under nutrition and over nutrition is

a serious problem in Nepal arising with

vulnerable groups either consuming

more or less than what is required.

Malnutrition in Nepal can be ascribed to

poor feeding and care, insufficient

nutrient intake, high rate of infections

and complications during pregnancy.

People from rural areas of Nepal are

affected by a triple threat: food

insecurity, low access to health services

and poor financial ability. Furthermore,

low level of literacy and awareness in

Nepal is also adding to the severity of the

problem.

This study was conducted through a

systematic investigation and analysis of

16 print and online media sources; to

identify the current scenario of nutrition in

Nepal and the current activities along

with efforts that have been made to

control and reduce the level of

prevalence of malnutrition by several

government and non-government

agencies. We sought to recognize the

current trends and issues associated with

nutrition as illustrated by the media

sources. We attempted to capture a

valid picture on nutritional situation in the

country particularly focusing on the

current situation, vulnerabilities, efforts

and progress made with regards to

nutrition in Nepal.

It is evident that prompt and immediate

actions are required by both the

government and the non-government

sector to deal with the problem of

nutrition in Nepal. Better polices to ensure

food security and quality of diet is crucial

in reducing if not eliminating the extent

of problem that persists in modern day

Nepal. More direct and concentrated

effort is required to see off the problem

anytime soon.

INTRODUCTION

Malnutrition is a serious condition that

occurs when a person’s diet does not

contain the right amount of nutrients as

needed by the body. A malnourished

individual lacks strength to undertake

routine activities and has reduced

concentration levels among children.

Good nutrition is prerequisite for the

national development and for the well-

being of individuals. Although problems

related to poor nutrition affects the entire

population, women and children are

particularly vulnerable because of their

unique physiology and socio-economic

characteristics. Nutrition plays a critical

role in child’s growth and development

and the period from birth to age two is

important for optimal growth and

development. However, in Nepal,

children falling under this age group are

found with severe micronutrient

deficiencies resulting in childhood illness

such as diarrhoea and respiratory

infections.

Malnutrition and diseases seem to work

in a deadly cycle. A malnourished child

is more likely to suffer from diseases, and

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the more they suffer from disease the

more likely they are to be malnourished.

Likewise, a woman’s nutritional status is

also important as this determines not only

her health but also the health of her

children. Malnourished women are

economically unproductive and are

more likely to get infected and recover

slowly from illness and have increased

chances of complications during

pregnancy. Their children are also likely

to give birth to children with low birth

rate, and this cycle continues. It is quite

obvious that the problem of malnutrition

is still being overlooked and it requires

immediate attention by all relevant

stakeholders at all levels.

This media monitoring involved tracking

down of relevant media stories with

respect to nutrition and food security in

order to identify the current state of

malnutrition and the attempts that are

being made to improve the situation. We

aimed to take a closer look on the

context of nutrition in Nepal and to track

down nutritional campaigns, identify

trends, discover the prevalence level, to

understand how agencies aid and

donors are engaged in it, and to

understand how media and other

agencies are responding to it. This study

also attempts to the draw attention of

concerned authorities and researchers,

to explore further and acquire more

information regarding the nature and

extent of problem which can be helpful

in revising the current approaches and

in achieving the goal of eradicating

hunger and malnutrition from Nepal.

METHODOLOGY

This media monitoring study was carried

out for the period of one month from

February 12 to March 13 (Falgun 2073 BS).

We collected various stories by

conducting daily media monitoring of

national mainstream and online sources

viz.: The Himalayan Times, Republica, The

Kathmandu Post, Kantipur, Naya Patrika,

Rajdhani, Annapurna Post, The Rising

Nepal, Gorkhapatra, Nepali Times, Himal

Khabar, Online Khabar, Setopati,

Pahilopost and Nepal Khabar. In

addition to that, random search was also

carried out in the internet with the

keyword ‘nutrition’.

During this period, we managed to

gather a total of 24 media stories related

to nutrition. The collected stories were

recorded in Microsoft Excel detailing the

date, title, sources and links to the story.

The stories were then synthesised and

categorised into various themes and

sub-themes. Therefore, three-step

process was followed: information

finding, information recording, and

analysis. The major findings from out

media monitoring study are as follows;

MAJOR FINDINGS

The major finding from the stories in

media have been broadly categorized

into the following categories; Current

Scenario, Issues and Efforts Made.

CURRENT SCENARIO

According to the stories presented in the

news sources the situation of malnutrition

in Nepal seems critical. A story in Naya

Patrika reports that a 2.5 months old

infant from Lamjung has been suffering

from malnutrition due to financial crisis in

her family. She is the first daughter of 16

years old Anju and Govinda Budaprithi.

Her mother neglected taking proper

food during her pregnancy and despite

of her awareness on importance of

nutritious diet during pregnancy, she was

deprived from it due to her financial

inability.

http://www.enayapatrika.com/2017/02/12/125388/http://www.enayapatrika.com/2017/02/12/125388/

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Source: Naya Patrika, February 14

Similarly, according to a story in

Annapurna Post, Dadeldhura’s Sarathi

Budhair, was deprived of nutritious diet

during her pregnancy as she was unable

to afford the diets recommended by the

doctors. Her twin daughters are both

malnourished now. Similarly a 20-month

old Ayush Roka of Kalikot is also

malnourished. Her mother gave birth at a

very young age and did not have much

knowledge about food intake or

pregnancy during the time.

The level of ignorance on nutrition and

healthy food among Nepalis is

unbelievable according to an article in

My Republica. It suggests that lack of

awareness is the main reason behind

Nepal’s malnutrition problem. The article

suggests that most kids are fine until they

are breastfeeding and start developing

deficiencies as they start going to school,

this is particularly true in urban areas

where little children have to walk for

hours to reach school and don’t eat

anything during their day. Even when

they return home, in most cases, their

parents tend to be so busy and they

don’t have time to cook meals in the

afternoon, and children have to wait till

dinner for a decent meal. Another

important issue is the type of food Nepali

people tend to consume. People do not

follow a balanced approach to their

diets in Nepal and emphasise on eating

large amount of rice, dhedo or potatoes.

As long as their belly is full, they don’t

seem to care much about the vital

nutrients they are missing out on.

A news report on The Himalayan Times

mentions that a recent report released

by DPHO in Bajura has revealed that

malnourished girls outnumber the boys

by a huge margin in the district. In the

district 727 girls out of 135 children were

reported to be suffering from

malnutrition. DPHO has also claimed that

many mothers tend to actively

participate in breastfeeding only if their

child was a boy. Another story involves a

six year old girl named Om Maya Mijar of

Dhading who has been battling

malnutrition from birth. She is the third

daughter of 26 years old Juthi Mijar who

is both underweight and much shorter

than normal for her age and has

problems with sitting and waling

properly. Juthi has 5 children and is

currently pregnant and all her children

are reported to be malnourished. Juthi

says that they have very little food and

can barely manage one mean per day.

In Dhading, more than 100 children are

malnourished particularly from the Dalit

and the chepang community. Although

the government and various non-

government organizations have

reportedly launched nutrition

programmes here, no results have been

reported. More than 700 children are

known to be malnourished in the district.

Another story in The Himalayan Times

involves a 14-month-old boy has

succumbed to malnutrition in Pajaru of

Jajarkot district on Wednesday. Anegat

Nepali who was first son to Hira Nepali

and Karna Bahadur Nepali. The child

weighed only five kg and was receiving

treatment. However, he breathed his last

while being taken to the district

headquarters for further treatment last

night. It has been learned that the child’s

parents were busy taking him to shamans

for treatment rather than going to a

medical facility earlier.

http://www.enayapatrika.com/2017/02/12/125388/http://www.annapurnapost.com/epaper/detail/271#&gid=1&pid=11http://www.myrepublica.com/news/15781?categoryId=117https://thehimalayantimes.com/nepal/malnutrition-afflicts-girls-boys/https://thehimalayantimes.com/nepal/malnutrition-afflicts-girls-boys/https://thehimalayantimes.com/nepal/14-month-old-dies-malnutrition-jajarkot/

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In Hetauda, over 8% children have been

found to be malnourished, and most of

them are victims of the April earthquake

and belong from areas where food

scarcity prevail. It has been found that

people living in temporary sheds are

prone to be malnourished. In the district

about 500 children have been found to

be severely malnourished and 2400

children to be suffering from mild

malnutrition.

ISSUES

The major issues reported through media

stories on nutrition for this month is the

obstruction of immunisation programmes

in several districts from Terai regions. A

report in My Republica has covered the

story of polio vaccine administration

programme has been obstructed due to

protest of health workers in various

districts. A programme which had not

been interfered during the 10 years of

insurgency, has been barricaded by the

health workers themselves. In Kailali, the

immunisation programme has been

obstructed due to protests of the health

workers. The protest had delayed the

arrival of necessary vaccine affecting

116, 846 children below five years of age

in the district and the case is similar for 15

other districts.

In Nepal, malnutrition is caused by a

series of underlying factors ranging from

cultural beliefs and superstitions,

widespread poverty, poor health

facilities, sanitation, early childcare

practices and agricultural investments..

Political instability and frequently

changing government has affected the

nutrition programmes and nutrition

specific policies.

EFFORTS MADE

It has to be acknowledged that several

efforts have been made to improve the

nutritional status in Nepal by both public

and private agencies and noticeable

progress has been made in this regard. A

news story in The Himalayan Times, a

nutrition programme to eradicate

malnutrition in children from Ramechhap

district has become successful, with

almost all children successfully treated.

The programme was launched with the

help of UNICEF after the 2014 earthquake

to identify and treat malnourished

children. According to District Health

Office, Dhading, in a survey among

28,682 children, most were found to be

malnourished in varying degrees. The

DHO said that shelters have been

established to treat severe malnutrition in

11 places, and mild malnutrition in 32

places in the district.

Source: The Himalayan Times

A story in Naya Patrika mentions that

upon hearing the story of Anju and

Govinda Budaprithi’s 2.5 month old

daughter from Lamjung, an employee

from Naya Patrika, Deepak Adhikari had

provided 10,000 Rupees as help to the

couple. The money was provides to buy

and feed proper food to the infant

daughter. Such small contributions could

prove to be invaluable to the couple

and their daughter.

http://kantipur.ekantipur.com/news/2017-02-22/20170222082000.htmlhttp://www.myrepublica.com/news/15882?categoryId=24http://www.myrepublica.com/news/15866?categoryId=24https://thehimalayantimes.com/nepal/nutrition-drive-yielding-results-ramechhap-vdcs/https://thehimalayantimes.com/nepal/malnutrition-afflicts-girls-boys/https://thehimalayantimes.com/nepal/malnutrition-afflicts-girls-boys/https://thehimalayantimes.com/nepal/nutrition-drive-yielding-results-ramechhap-vdcs/http://www.enayapatrika.com/2017/02/13/125484/

4 | P a g e

Source: Naya Patrika, February 13

Some positive stories have also been

reported. According to a news story in

Gorkhapatra, the cases of malnutrition

has been declining in Kavrepalanchowk

district. The number of children suffering

from malnutrition has gone down to 500

from 3535 within the past two years

according to the DHO in Kavre. The

cases were extremely high during the

time of the earthquake as much children

were deprived of proper food. However,

the situation has improved a lot in the

district.

Furthermore, according to news stories

reported in The Kathmandu Post,

Nagarik, Annapurna Post, Gorkhapatra

and Naya Patrika, the Ministry of Health

has decided to book 18 government

officials, including chiefs of three district

health offices for obstructing the polio

vaccination campaign. They have

Source: Annapurna Post, March 5

been asked to provide a written

clarification within three days why

departmental action should not be

taken against them which could affect

their career prospects.

According to My Republica the Ministry

of Health is also planning to relocate the

some health staffers after their protests

reportedly affected the polio

immunisation program in 15 districts. A

day after the two-day polio vaccination

programme obstruction, the

government on Monday launched door-

to-door polio administration drive in 15

districts of the country to ensure that

children are not deprived of regular

immunisation according to The

Kathmandu Post.

Source: My Republica, March 5

In addition to it, WHO office for South-

East Asia has called for a healthier future

for newborns and mothers in several

countries including Nepal. They have

concentrated their attention and have

designed strategies to help support

nations in overcoming the problem of

malnutrition. In the South-East Asia

Region, each year birth defects are

responsible for an estimated 90,000

newborn deaths, said the UN health

agency. WHO office in SEA has called for

a healthier future for newborns and

mothers in several countries including

Nepal. They have concentrated their

attention and

http://www.enayapatrika.com/2017/02/13/125484/http://gorkhapatraonline.com/epaper/showimage?img=uploads/epaper/2017-02-16/1b87f3e6e720972c351327d70f00f04f.jpghttp://kathmandupost.ekantipur.com/news/2017-03-06/18-officials-booked-for-disrupting-polio-drive.htmlhttp://www.nagariknews.com/news/15511http://www.annapurnapost.com/news/65804http://gorkhapatraonline.com/epaper/showimage?img=uploads/epaper/2017-03-06/89a338ce7206e106de934031e63c392e.jpghttp://www.enayapatrika.com/2017/03/06/129879/http://www.enayapatrika.com/2017/03/06/129879/http://www.myrepublica.com/news/15844?categoryId=24http://kathmandupost.ekantipur.com/printedition/news/2017-03-07/govt-starts-door-to-door-drive.htmlhttp://kathmandupost.ekantipur.com/printedition/news/2017-03-07/govt-starts-door-to-door-drive.htmlhttp://www.myrepublica.com/news/15882/?categoryId=24https://thehimalayantimes.com/kathmandu/who-calls-for-healthier-future-for-newborns-and-mothers/

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DISCUSSIONS

This report suggests that the threat

malnutrition bears on infants and

mothers in Nepal is colossal. Even today

we find news of children dying from

malnutrition and related diseases. Infants

and children have continued to die over

the past few decade just because of

inadequate diet. Nepal is one of the

poorest countries in the world with many

people living under the poverty line.

Many mothers have been deprived of

nutritious food during pregnancy and

new born infants are not fed adequately

during their first years of life. Even in cases

where the mother is well aware about

the importance of nutritious food for her

and her baby’s wellbeing, there are

cases where proper food is inaccessible

to them either due to geographical

contains or financial inability.

Furthermore, girls marrying at early and

giving birth at an early age is another

underlying factor behind malnutrition

and child mortality in Nepal. Women

from rural part of Nepal are widely

engaged in the practice of child

marriage. They are likely to have up to 4

children before they reach age of 20.

Without any sort of financial soundness

and income source, they keep giving

birth to more and more children. This has

resulted in the children being

malnourished and leaving them

vulnerable to many illness. Such parents

usually are illiterate and unaware of the

importance of nutrition for their and their

children’s wellbeing and belong to the

rural parts of the country.

Even among the children who are

breastfed well are likely to suffer from

malnutrition as they start going to school.

Schools in Nepal do not provide food

and are located far away from the rural

villages. Children walk for hours each

day to reach school and spend a lot of

energy in doing so but their food intake is

not proportional to the calories they

waste during the day. Even when they

eat, they may not eat healthy. Nepali

people seem to have irregular diet

patterns with tendency to eat large

amount of rice and ignore other nutrients

that they are missing out from their diet.

Health seeking behaviour and

availability of quality and accessible

services at health facilities is also

prevalent in Nepal. Although the

treatment and facilities for treating

malnutrition has become more efficient

in Nepal, most patients, especially from

rural areas, have little or no access to

formal health services and do not visit the

health facilities.

There is existing belief on shamans and

traditional healers. Lack of education

and knowledge particularly in the most

rural areas have contributed towards

people believing that illness is a

consequence of making the Gods and

Goddesses angry. They prefer sacrificing

animals as a remedy for malnutrition

than seek professional medical help.

Several protests and strikes in many

districts of Nepal obstructed the

administration of polio vaccines. The

protest delayed the arrival of medicines

and had halted the immunisation

programme in several districts.

Thousands of children and mothers were

sent back home without vaccination.

This is violation of people’s right to access

health services. Policy makers and

national leaders are preoccupied with

their own agendas and have shown

lesser regard to the substantial problem

of malnutrition in Nepal.

Causes of maternal and child

malnutrition in Nepal constitute of

poverty, socio-cultural, geographical

and economic factors, among others

while the underlying causes are lack of

quality diversified diet, poor caring, lack

of education and low utilisation of

available health services. Many

programmes and activities have been

6 | P a g e

undertaken by several national and

international agencies in Nepal. Results

have also been obtained but not up to

the mark. The government and agencies

have been trying to eradicate the

problem in coordination with several

international donors and agencies.

Responsibilities need to be taken by all

relevant stakeholders if we aim to reduce

the burden of the problem anytime soon.

CONCLUSION AND

RECOMMENDATIONS

Addressing malnutrition among children

is pre-requisite for all social and

economic development, and is vital for

achievement of all Sustainable

Development Goals (SDGs). Good

nutrition provides a strong base for

development of the country and

provides the much needed structure to

ensure that people physically and

mentally capable to achieve their

potential. This would require attention

and effective actions by all relevant

stakeholders. Investing in nutrition has

great benefits from improving an

individual’s health to economic

prosperity in the long run. Effective

polices and interventions must come into

play if they ought to bring changes at

the grass-root level of the community.

Government and non-government

agencies need to take responsibilities

and work in coordination to derive

impact and reduce the burden imposed

by malnutrition to the individuals, their

families and the country as a whole.

Adequate nutrition is a fundamental

right. Nutrition plays vital role in the

growth and development of the children

not just physical growth but also mental

and cognitive capacity of mind

develops in between conception to

second birthday of a child also called

first 1000 days. Nutrition advocacy, promotion and support efforts should be

ensured to reach the needy and

marginalised populations. Mere policy

and strategy cannot yield foreseeable

results, they have to be effectively

implemented. There is a strong need to

improve the health service delivery

systems which can ensure the desired

change.

The programmes on nutrition needs to be

integrated with livelihood activities to

reduce the extent of children suffering

from acute malnutrition. Better

communication mechanisms needs to

be set up for an effective two way

communication to occur which could

prove vital in raising the awareness level

and dissemination of life saving

information to the vulnerable people.

Furthermore, the government needs to

encourage the agricultural production in

order to reduce poverty and food

scarcity. By investing in nutrition-sensitive

agricultural programmes, there can be

sustained impact on health and

productivity of families.

Women’s access to adequate nutrition,

including folic acid and iodine must be

guaranteed through supplementation or

food fortification. The enjoyment of an

environment free of harmful chemicals,

too, should be assured. And vaccination

coverage that can protect pregnant

women and their unborn babies from

defect-causing diseases such as rubella

needs universal access. All concerned

sectors such as local development,

agriculture, health, education are

responsible for improving nutrition for

mothers, newborns and children under

the age of 5. Long term nutrition goals of

the country to be oriented towards

significantly reducing malnutrition to the

point that it is no longer an impending

factor towards development.

HERD is a dynamic national non-governmental organisation,

promoting evidence informed policies and practices for

sustainable development in health, environment and social

sectors to improve quality of life.

Cover final2Media Monitoring Report on Nutrition - Falgunlast page